Screw tower and rod reduction tool

ABSTRACT

A system includes a screw tower, an instrument, and a housing. The instrument includes a driver shaft extendable longitudinally through the screw tower, and a threaded sleeve mounted on a proximal portion of the driver shaft. The housing includes one or more retention members coupleable to the screw tower, and a threaded button threadably coupleable to the threaded sleeve. The threaded sleeve is rotatable about a longitudinal axis to urge the driver shaft longitudinally relative to the screw tower.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application is a continuation application of U.S. patentapplication Ser. No. 17/382,782 filed on Jul. 22, 2021, the contents ofwhich are incorporated by reference herein in its entirety for allpurposes.

BACKGROUND

Spinal fixation devices may be anchored to specific portions of thevertebra. Such spinal fixation devices may include, for example, a shankportion coupleable to a vertebra, and a head portion having a receivingelement. A fixation rod may be seated through the receiving element andlocked in place by tightening the head portion. While known spinalfixation systems have proven effective, some rod reducers may bedifficult, tiresome, and/or time-consuming to use.

SUMMARY

According to some examples of the inventive concepts described herein, asystem may be provided to provide a rod reduction tool. The systemincludes a screw tower, an instrument, and a housing. The instrumentincludes a driver shaft extendable longitudinally through the screwtower, and a threaded sleeve mounted on a proximal portion of the drivershaft. The housing includes one or more retention members coupleable tothe screw tower, and a threaded button threadably coupleable to thethreaded sleeve. The threaded sleeve is rotatable about a longitudinalaxis to urge the driver shaft longitudinally relative to the screwtower.

According to other examples of the inventive concepts described herein,a method may be provided to provide a rod reduction tool. The methodincludes extending a driver shaft longitudinally through a screw tower,mounting a threaded sleeve on a proximal portion of the driver shaft,coupling a housing to the screw tower using one or more retentionmembers, and threadably coupling the housing to the threaded sleeveusing a threaded button such that the threaded sleeve is rotatable abouta longitudinal axis to urge the driver shaft longitudinally relative tothe screw tower.

This summary is provided to introduce a selection of inventive conceptsin a simplified form that are further described below in the detaileddescription. Other methods and related systems, and correspondingmethods and computer program products, according to examples of theinventive subject matter will be or become apparent to one with skill inthe art upon review of the following detailed description and theaccompanying drawings. This summary is not intended to identify keyfeatures or essential features of the claimed subject matter, nor is itintended to be used as an aid in determining the scope of the claimedsubject matter.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included to provide a furtherunderstanding of the disclosure and are incorporated in and constitute apart of this application, illustrate certain non-limiting examples ofinventive concepts. In the drawings:

FIG. 1 is a side view of an example screw tower;

FIG. 2 is a front view of the screw tower shown in FIG. 1 ;

FIG. 3 is a cross-sectional view of the screw tower shown in FIG. 1 ;

FIG. 4 is an exploded perspective view of the screw tower shown in FIG.1 ;

FIG. 5 is a cross-sectional view of another example screw tower;

FIG. 6 is an exploded perspective view of the screw tower shown in FIG.5 ;

FIG. 7 is a side view of an example instrument that may be used with ascrew tower, such as the screw tower shown in FIG. 1 or 5 ;

FIG. 8 is an exploded perspective view of the instrument shown in FIG. 7;

FIG. 9 is a cross-sectional view of another example instrument that maybe used with a screw tower, such as the screw tower shown in FIG. 1 or 5;

FIG. 10 is a distal end view of the instrument shown in FIG. 9 ;

FIG. 11 is a proximal end view of an example screw tower, such as thescrew tower shown in FIG. 1 or 5 ;

FIG. 12 is a partially transparent side view of an example housing thatmay be used with a screw tower, such as the screw tower shown in FIG. 1or 5 , and/or an instrument, such as the instrument shown in FIG. 7 or 9;

FIG. 13 is a partially transparent front view of the housing shown inFIG. 12 ;

FIG. 14 is a partially transparent, exploded perspective view of thehousing shown in FIG. 12 ;

FIG. 15 is a block diagram of an example tracking system that may beused to track one or more objects, such as the screw tower shown in FIG.1 or 5 , the instrument shown in FIG. 7 or 9 , and/or the housing shownin FIG. 12 ;

FIG. 16 is a perspective view of example objects that may be tracked,including example tracking markers;

FIG. 17 is a perspective view of the objects shown in FIG. 16 in apartially overlapping arrangement;

FIG. 18 is a perspective view of the objects shown in FIG. 16 in anexample use arrangement;

FIG. 19 is a perspective view of another example object that may betracked, including example tracking markers;

FIG. 20 is a block diagram of an example computing system that may beused to track one or more objects, such as the screw tower shown in FIG.1 or 5 , the instrument shown in FIG. 7 or 9 , and/or the housing shownin FIG. 12 ;

FIG. 21 is a schematic illustration of an example tracking array andnavigation array-equipped rod in a first phase in which the trackingarray is coupled to a first screw tower and the navigationarray-equipped rod extends through the first screw tower;

FIG. 22 is a schematic illustration of the tracking array and navigationarray-equipped rod shown in FIG. 21 in a second phase in which thetracking array is coupled to a second screw tower and the navigationarray-equipped rod extends through the first and second screw towers;

FIG. 23 is a schematic illustration of an example visual aid for use inpositioning one or more objects, such as the navigation array-equippedrod shown in FIGS. 21 and 22 ;

FIG. 24 is a flow chart of an example method of providing a rodreduction tool in accordance with one example of the inventive subjectmatter;

FIG. 25 is a front view of an assembly including a pedicle screw, ascrew tower, such as the screw tower shown in FIG. 1 or 5 , aninstrument, such as the instrument shown in FIG. 7 or 9 , and a housing,such as the housing shown in FIG. 12 ;

FIG. 26 is a side view of the assembly shown in FIG. 25 ; and

FIG. 27 is a perspective view of the assembly shown in FIG. 25 .

The drawings, which are not necessarily to scale, depict selectedexamples and are not intended to limit the scope of the disclosure.Although specific features of various examples of the disclosure may beshown in some drawings and not in others, this is for convenience only.The following detailed description is to be read with reference to thedrawings, in which like elements in different figures have likereference characters.

DETAILED DESCRIPTION

The present disclosure relates to medical devices and, moreparticularly, to a screw tower and rod reduction tool. Examplesdescribed herein include a screw tower, an instrument, and a housing.The instrument includes a driver shaft extendable longitudinally throughthe screw tower, and a threaded sleeve mounted on a proximal portion ofthe driver shaft. The housing includes one or more retention memberscoupleable to the screw tower, and a threaded button threadablycoupleable to the threaded sleeve. The threaded sleeve is rotatableabout a longitudinal axis to urge the driver shaft longitudinallyrelative to the screw tower. The examples described herein enable ascrew tower to be affixed, a fixation rod to be reduced, and/or alocking cap to be inserted in an efficient, user-friendly, and/oreffective manner. While the examples described herein are described withrespect to pedicle screws, one of ordinary skill in the art wouldunderstand and appreciate that the example systems and methods may beused with other types of fastening mechanisms.

Turning now to the drawings, FIGS. 1-4 show an example screw tower 100that may be used to hold or engage a screw (e.g., a pedicle screw) forimplantation of the screw via a minimally-invasive incision. The screwtower 100 may include, for example, an elongated tube defining a distalopening 102 for receiving the screw at a distal end 104, a proximalopening 106 for receiving one or more instruments, rods, implants, etc.at a proximal end 108, and a channel 110 extending longitudinally (e.g.,along a Y-axis) therebetween.

In some examples, the screw tower 100 includes an outer sleeve 120sized, shaped, and/or configured to engage a portion of the screw. Forexample, the outer sleeve 120 may include a first wall 122 and a secondwall 124 opposing the first wall 122 such that a head feature of thescrew (e.g., a lip of a tulip) may be positioned transverselytherebetween. In some examples, the first wall 122 and/or second wall124 may be cantilevered such that the outer sleeve 120 may be coupled tothe screw using a cantilever snap-fit engagement. For example, as thehead feature of the screw is urged in a proximal direction (e.g., in anegative Y-direction) toward the distal end 104 of the outer sleeve 120,the first wall 122 and/or second wall 124 may deflect or spread apart toallow the head feature to move in the proximal direction therebetweenand return or snap back to a neutral configuration when the head featureclears a portion 126 of the first wall 122 and/or second wall 124 (e.g.,a ridge or lip) such that the portion 126 of the first wall 122 and/orsecond wall 124 is disposed in an undercut and/or opening defined by thehead feature of the screw. Alternatively, the outer sleeve 120 mayengage or be coupled to the screw using any arrangement or mechanismthat provides a quick, robust, and reliable connection. For example, insome examples, the outer sleeve 120 may be selectively rotated to couplethe screw tower 100 to the screw by positioning the portion 126 of thefirst wall 122 and/or second wall 124 in the undercut or opening definedby the head feature of the screw and/or uncouple the screw tower 100from the screw by spacing the portion 126 of the first wall 122 and/orsecond wall 124 from the undercut or opening defined by the head featureof the screw.

As shown at FIGS. 3 and 4 , the screw tower 100 may include an innersleeve 130 coaxial with the outer sleeve 120. In some examples, theinner sleeve 130 may be sized, shaped, and/or configured to engage aportion of the screw coupled to the outer sleeve 120 at the distal end104 thereof for “locking” or rigidly securing the screw in placerelative to the screw tower 100. For example, when the inner sleeve 130is moved or urged in a distal direction (e.g., in a positiveY-direction) while the outer sleeve 120 is coupled to the screw, thehead feature may be clamped longitudinally between a mating portion 132of the inner sleeve 130 (e.g., a tab or protrusion) and the portion 126of the first wall 122 and/or second wall 124. In some examples, themating portion 132 of the inner sleeve 130 may include one or moremating features that are sized, shaped, and/or configured to be receivedin one or more indented features and/or openings at the head of thescrew. Additionally or alternatively, the mating portion 132 of theinner sleeve 130 may include one or more mating features that are sized,shaped, and/or configured to receive one or more tabs and/or protrusionsat the head of the screw.

In some examples, an inner nut 134 may be used to move or urge the innersleeve 130 longitudinally relative to the outer sleeve 120. As shown inFIGS. 3 and 4 , the nut 134 may be threadably coupled to the outersleeve 120 such that the nut 134 may be rotated about the longitudinalaxis in a first direction (e.g., a clockwise direction) to move in thedistal direction and/or in a second direction opposite the firstdirection (e.g., a counterclockwise direction) to move in the proximaldirection (e.g., in a negative Y-direction). In some examples, aretaining clip or ring 136 may be used to couple the inner sleeve 130 tothe nut 134 such that the inner sleeve 130 and nut 134 are prevented orrestricted from moving longitudinally relative to each other while beingfree to rotate relative to each other. In this manner, the nut 134 maybe selectively rotated to longitudinally translate the inner sleeve 130relative to the outer sleeve 120. A relative orientation of the outersleeve 120 and inner sleeve 130 may be maintained, for example, toensure that the screw tower 100 includes one or more longitudinalchannels 138 defined therein. For example, as shown in FIGS. 2, 3, and 4, channels 138 may be defined circumferentially between the first wall122 and second wall 124 of the outer sleeve 120 (e.g., along acircumference of the outer sleeve 120). Channels 138 defined in theouter sleeve 120 may be aligned with channels 138 defined in the innersleeve 130 to allow one or more rods to extend transversely through thescrew tower 100. In some examples, channels 138 may be open at thedistal end 104 of the outer sleeve 120 and/or inner sleeve 130 such thatone or more transversely-extending rods may be received at the distalend 104 of the screw tower 100 and translated proximally (e.g., in anegative Y-direction) through the channels 138.

The screw tower 100 may include one or more control features 140 forcontrolling a relative movement between the outer sleeve 120 and innersleeve 130. In some examples, the control features 140 may restrict anamount or degree of allowable movement between the outer sleeve 120 andinner sleeve 130. For example, the control features 140 may include oneor more openings 142 defined in the outer sleeve 120, one or morelongitudinal slots 144 defined in the inner sleeve 130, and one or morepins 146 extendable through the openings 142 and/or longitudinal slots144. The openings 142 may be sized, shaped, and/or configured such that,when the pins 146 are extended therethrough, the outer sleeve 120 isrestricted or prevented from moving rotationally (e.g., about theY-axis) or longitudinally (e.g., along the Y-axis) relative to the pins146. The longitudinal slots 144 may be sized, shaped, and/or configuredsuch that, when the pins 146 are extended therethrough, the inner sleeve130 is restricted or prevented from moving rotationally (e.g., about theY-axis) relative to the pins 146 while being free to move longitudinally(e.g., along the Y-axis) relative to the pins 146 a length of thelongitudinal slots 144. For another example, the control features 140may include one or more longitudinal slots 148 defined in the outersleeve 120 and one or more tabs and/or protrusions 150 of the innersleeve 130 that are configured to extend radially outward through thelongitudinal slots 148. The longitudinal slots 148 may be sized, shaped,and/or configured such that, when the protrusions 150 are extendedtherethrough, the outer sleeve 120 is restricted or prevented frommoving rotationally (e.g., about the Y-axis) relative to the protrusions150 while being free to move longitudinally (e.g., along the Y-axis)relative to the protrusions 150 a length of the longitudinal slots 148.

In some examples, the control features 140 may be selectively disengagedto allow a relative movement between the outer sleeve 120 and innersleeve 130. For example, the pins 146 may be extracted or removed fromthe openings 142 defined in the outer sleeve 120 and the longitudinalslots 144 defined in the inner sleeve 130 such that walls defining theopenings 142 and/or longitudinal slots 144 do not engage the pins 146when the outer sleeve 120 and/or inner sleeve 130 is moved. For anotherexample, the first wall 122 and/or second wall 124 of the outer sleeve120 may be deflected or spread apart such that the protrusion 150 at adistal portion of the inner sleeve 130 is extracted or removed from thelongitudinal slot 148 at a distal portion of the outer sleeve 120 and,thus, does not engage the first wall 122 and/or second wall 124 when theouter sleeve 120 and/or inner sleeve 130 is moved. For yet anotherexample, the protrusion 150 at a proximal portion of the inner sleeve130 is moved or urged radially inward such that the protrusion 150 isextracted or removed from the longitudinal slot 148 at a proximalportion of the outer sleeve 120 and, thus, does not engage the firstwall 122 and/or second wall 124 when the outer sleeve 120 and/or innersleeve 130 is moved. In some examples, a separate tool may be used toselectively disengage one or more control features 140 to allow thescrew tower 100 to be at least partially disassembled (e.g., forsterilization and/or cleaning).

FIGS. 5 and 6 show another example screw tower 160 that may be used tohold or engage a screw for implantation of the screw via aminimally-invasive incision. As can be understood from a comparison ofFIGS. 3 and 4 with FIGS. 5 and 6 , the screw tower 160 shown in FIGS. 5and 6 is substantially similar to the screw tower 100 shown in FIGS. 3and 4 , except the screw tower 160 includes an inner nut 164 (e.g.,inner nut 134) having a compressible ledge 166. The compressible ledge166 is configured to engage an inner surface of the inner sleeve 130such that the inner sleeve 130 and nut 164 are prevented or restrictedfrom moving longitudinally relative to each other while being free torotate relative to each other. In this manner, the nut 164 shown inFIGS. 5 and 6 is selectively rotatable to longitudinally translate theinner sleeve 130 relative to the outer sleeve 120. As shown in FIGS. 5and 6 , the nut 164 may be threadably coupled to the outer sleeve 120such that the nut 164 may be rotated about the longitudinal axis in afirst direction (e.g., a clockwise direction) to move or urge the innersleeve 130 in the distal direction and/or in a second direction oppositethe first direction (e.g., a counterclockwise direction) to move or urgethe inner sleeve 130 in the proximal direction (e.g., in a negativeY-direction).

FIGS. 7 and 8 show an instrument 200 that may be used to reduce a rodand/or insert a locking cap on a screw. The screw may include or becoupled to a tulip on which the rod may be positioned, and the lockingcap may be used to secure the rod within the tulip. The instrument 200may be extended longitudinally between the proximal end 108 and thedistal end 104 and/or used with the screw tower 100 (shown in FIGS. 1-4). In some examples, the instrument 200 includes a driver or inner shaft210 sized, shaped, and/or configured to push or drive a rod extendingtransversely through the longitudinal channels 138 of the screw tower100 in a distal direction (e.g., in a positive Y-direction). The rod maybe pushed or driven, for example, by extending the inner shaft 210through the channel 110 of the screw tower 100 to position the distalend 104 of the inner shaft 210 at or adjacent to the rod and moving orurging the inner shaft 210 in the distal direction.

As shown in FIGS. 7 and 8 , a cap pusher 212 may be mounted on orcoupled to a distal portion of the inner shaft 210. The cap pusher 212may be sized, shaped, and/or configured to engage the locking cap andprovide a force to the locking cap such that the locking cap may becoupled to the tulip (e.g., for use in securing the rod therein). Insome examples, the instrument 200 may include or be used with anindicator that indicates a position of the rod in order to ensure thatthe rod is reduced before coupling the locking cap to the tulip.

In some examples, the inner shaft 210 and cap pusher 212 may beconfigured to simultaneously engage the rod and locking cap,respectively. For example, the inner shaft 210 may be extended throughan opening in the locking cap to directly contact the rod, and thedistal end 104 of the inner shaft 210 may be longitudinally spaced oroffset from the distal end 104 of the cap pusher 212, such that theinner shaft 210 and cap pusher 212 are configured to contact the rod andlocking cap, respectively. In some examples, the instrument 200 mayinclude one or more biasing members 214 (e.g., springs) that absorb ormitigate a force applied to the locking cap (e.g., by the cap pusher)during rod reduction. The biasing members 214 may be housed, forexample, in a concealing cap 216 coupled to the inner shaft 210. Theconcealing cap 216 may include an opening sized, shaped, and/orconfigured to allow the inner shaft 210 and cap pusher 212 to extendlongitudinally therethrough. In some examples, a retaining ring 218 maybe positioned at a distal portion of the inner shaft 210 to facilitatekeeping the locking cap retained to the instrument 200. The retainingring 218 may be coupled to the distal portion of the inner shaft 210,for example, via a friction fit.

As shown in FIGS. 7 and 8 , the instrument 200 may include a threadedsleeve 220 mounted on or coupled to a proximal portion of the innershaft 210. The inner shaft 210 is free to rotate and/or translateindependent of the threaded sleeve 220. The threaded sleeve 220 may besized, shaped, and/or configured to engage a shoulder 222 of the innershaft 210 for use in moving or urging the inner shaft 210 in the distaldirection (e.g., in a positive Y-direction). In some examples, a washer224 may be positioned longitudinally between the inner shaft 210 andthreaded sleeve 220 to facilitate reducing friction and/or distributingforces applied therebetween.

A driver nut 230 may be coupled to the distal end 104 of the threadedsleeve 220 for use in rotating the threaded sleeve 220. The driver nut230 may urge the threaded sleeve 220 to rotate about the longitudinalaxis. A coupling mechanism 232 may be used to couple the driver nut 230to the threaded sleeve. The coupling mechanism 232 may be, withoutlimitation, an assembly screw.

FIGS. 9 and 10 show another example instrument 240 that may be used toreduce a rod and/or insert a locking cap on a screw. As can beunderstood from a comparison of FIGS. 7 and 8 with FIGS. 9 and 10 , theinstrument 240 shown in FIGS. 9 and 10 is substantially similar to theinstrument 200 shown in FIGS. 7 and 8 , except, as shown in FIG. 10 ,the inner shaft 250 of the instrument 240 includes one or more keyedfeatures 252 at a radially outer surface thereof. The keyed features 252may be configured to engage a radially-inner surface of a screw tower(e.g., screw tower 100 or 160). For example, as shown in FIG. 11 , ascrew tower 100 may include one or more keyed features 254 thatcomplement the keyed features 252 of the instrument 240. In this manner,the keyed features 252 and 254 may engage each other when the innershaft 250 extends through the channel 110 of the screw tower 100. Thekeyed features 252 and 254 provide anti-rotation properties by matingwith the screw tower 100. This in turn restricts or prevents crossthreading of the driver nut 230 (e.g., under heavy reduction loads).

FIGS. 12-14 show a selective thread engagement housing 300 that may beused to selectively move and/or position the screw tower 100 and/orinstrument 200. In some examples, the housing 300 includes an openingsized, shaped, and/or configured to receive the proximal end 108 of thescrew tower 100. The housing 300 may include one or more retentionmembers or tower clips 310 configured to selectively engage or clamp toa proximal portion of the screw tower 100. In some examples, each towerclip 310 is pivotable about a respective rod 312 to move between anengaged position, in which a portion of the tower clip 310 (e.g., aridge or lip) engages an outer surface of the screw tower 100 tofacilitate preventing or restricting the screw tower 100 and housing 300from moving longitudinally relative to each other, and a disengagedposition, in which the portion of the tower clip 310 is spaced from thescrew tower 100 such that the screw tower 100 and housing 300 are freeto move longitudinally relative to each other.

The housing 300 may include a threaded button 320 configured to engageor mate with the threaded sleeve 220 of the instrument 200. The threadedbutton 320 may include, for example, an opening 322 sized, shaped,and/or configured to receive the threaded sleeve 220 therethrough. Insome examples, the opening 322 may be at least partially defined by athreaded wall 324. In this manner, a driving force of rod reduction maybe accomplished by selectively rotating the threaded sleeve 220 whilethe housing 300 is rigidly secured to the screw tower 100 (e.g., via thetower clips 310) and threadably coupled to the instrument 200 (e.g., viathe threaded sleeve 220).

In some examples, the threaded button 320 may be moved transverselyacross the housing 300 to allow for variable reduction. For example,moving the threaded button 320 in a first transverse direction (e.g.,radially outward) may cause the threaded wall 324 to engage an outersurface of the threaded sleeve 220 such that the threaded sleeve 220 maymove in the distal direction by rotating about the longitudinal axis ina first direction (e.g., a clockwise direction) and/or move in theproximal direction by rotating about the longitudinal axis in a seconddirection opposite the first direction (e.g., a counterclockwisedirection). On the other hand, moving the threaded button 320 in asecond transverse direction (e.g., radially inward) may cause thethreaded wall 324 to be spaced from the threaded sleeve 220 such thatthe instrument 200 and housing 300 are free to move relative to eachother (e.g., for rapid adjustment).

As shown in FIG. 14 , the housing 300 may include one or more biasingmembers 328 (e.g., springs) that urge the tower clips 310 and/orthreaded button 320 toward the engaged position, thereby supporting orpromoting mechanical threaded reduction via rotation of the threadedsleeve 220. Additionally or alternatively, a button pin 326 may bepositioned to prevent or restrict the threaded button 320 from moving inthe second transverse direction (e.g., toward a disengaged position).Moreover, to facilitate preventing or restricting the threaded button320 from moving in the second transverse direction during heavyreduction loads, a proximal portion of the threaded button 320 mayinclude a shallow ledge configured to engage or catch on an outersurface of the housing 300 when a heavy reduction load is applied. Insome examples, the threaded wall 324 may include a square thread profilethat facilitates increasing axial force (e.g., for use in rod reduction)and/or reducing friction between the threaded wall 324 and the outersurface of the threaded sleeve 220 (e.g., when the threaded button 320is moved in a transverse direction).

The housing 300 may be clipped onto the screw tower 100 before theinstrument 200 is inserted into the housing 300, or clipped onto thescrew tower 100 with the instrument 200 already extending at leastpartially through the housing 300. In some examples, the housing 300 mayinclude or be coupled to a counter-torque instrument, acompressor/distractor instrumentation, and/or other tower manipulationinstrumentation.

FIG. 15 shows an example tracking system 400 that may be used to trackone or more objects, such as the screw tower 100, instrument 200, and/orhousing 300. The system 400 includes one or more position sensors 410that may be positioned and/or oriented to have a direct line of sight toa surgical field. In some examples, a position sensor 410 may bepositioned on a stand configured to move, orient, and support theposition sensor 410 in a desired position and/or orientation. Theposition sensors 410 may include any suitable camera (e.g., an infraredcamera, a bifocal camera, a stereophotogrammetric camera, etc.)configured to scan a given measurement volume and detect light and/orother electromagnetic wave that comes from a plurality of trackingmarkers 420 in order to determine a position of the tracking markers 420in the given measurement volume.

In some examples, the tracking markers 420 may be mounted or otherwisesecured to an object to be tracked during a surgical procedure (e.g.,screw tower 100, instrument 200, housing 300). Such objects may include,without limitation, a robot (e.g., at an end-effector), a surgical tool,and/or a patient tracking device secured directly to a patient. In someexamples, electromagnetic waves coming from the tracking markers 420 maybe detected over time in order to monitor a position and/or movement ofone or more marked objects (e.g., an object having tracking markers 420coupled thereto).

Tracking markers 420 may serve as unique identifiers that are trackablein three dimensions (e.g., using stereophotogrammetry). Tracking markers420 may include active tracking markers (e.g., infrared light emittingdiodes (LEDs)) that are activated by an electrical signal to emit lightand/or other electromagnetic wave, and/or passive tracking markers(e.g., retro-reflective markers) that reflect light and/or otherelectromagnetic wave emitted by an illuminator on the position sensor410 or other suitable device. In some examples, the tracking markers 420may include reflective, radiopaque, and/or optical markers. The trackingmarkers 420 may be suitably shaped, including spherical, spheroid,cylindrical, cube, cuboid, or the like.

A computer 430 may receive and process information from the positionsensors 410 in order to present information to a user using a display432 and/or a speaker 434. In some examples, the computer 430 may includea processor circuit 440 (also referred to as a processor) coupled withan input interface circuit 442 (also referred to as an input interface),an output interface circuit 444 (also referred to as an outputinterface), and/or a memory circuit 446 (also referred to as a memory).The memory 446 may include computer readable program code that whenexecuted by the processor 440 causes the processor 440 to performoperations according to embodiments disclosed herein. According to otherexamples, the processor 440 may include memory so that a separate memorycircuit (e.g., memory 446) is not required.

The processor 440 may receive input through the input interface 442,and/or provide output through the output interface 444. For example, theprocessor 440 may receive position sensor data associated with one ormore tracking markers 420 from the position sensor 410 through the inputinterface 442, and/or present position information to the user using thedisplay 432 and/or speaker 434 through input interface 442. In someexamples, the position and/or orientation of a marked object may bepresented to the user in relation to a three-dimensional image of apatient's anatomical structure.

FIGS. 16-18 show an example first object 500 marked with an examplefirst cluster of stripes 502 and an example second object 510 markedwith an example second cluster of stripes 512. In some examples, thecomputer 430 may be configured to discern between tracking markers 420(e.g., first cluster of stripes 502, second cluster of stripes 512) bydistinguishing inter-stripe spacing (e.g., longitudinal spacing betweenstripes of a cluster). For example, the first cluster of stripes 502 hasa first inter-stripe spacing, and the second cluster of stripes 512 hasa second inter-stripe spacing larger than the first inter-stripespacing.

Each object may be marked at a plurality of locations. For example, thefirst cluster of stripes 502 is present in two different locations ofthe first object 500, and the second cluster of stripes 512 is presentin two different locations of the second object 510. In some examples,the computer 430 may be configured to discern between objects (e.g.,first object 500, second object 510) by distinguishing marker types andinter-cluster spacing (e.g., longitudinal spacing between clusters). Forexample, the first object 500 has a first inter-cluster spacing, and thesecond object 510 has a second inter-cluster spacing larger than thefirst inter-cluster spacing.

The first cluster of stripes 502 and second cluster of stripes 512 mayeach be configured to uniquely identify a respective object (e.g., firstobject 500 and second object 510, respectively). For example, thecomputer 430 may be configured to recognize the first object 500 basedon the first cluster of stripes 502 and/or the second object 510 basedon the second cluster of stripes 512.

When searching tracked frames for tracking markers 420, the computer 430may compare the tracked frames to a geometrical model of the cluster ofstripes (e.g., first cluster of stripes 502, second cluster of stripes512), treating the cluster of stripes as a unique marker. Because thecomputer 430 is searching for a match to a plurality of parametersincluding cylindrical shape of predetermined diameter and stripes of apredetermined curvature in a sequence of a predetermined number (e.g.,five) spanning a predetermined longitudinal length, the computer 430 mayfind a match and locate its center even if a portion of the object ispartially blocked as shown in FIG. 17 . That is, the differentinter-stripe spacing and/or inter-cluster spacing allows the computer430 to easily discern between tracking markers 420 and/or objects whilealso finding accurate locations. For example, on second object 510 asshown in FIG. 17 , the comparison to the geometrical model may considerthe curvature of the visible stripes and determine that the visibleportion of the tracking markers 420 represents the right half of thetracking markers 420. In this manner, example approaches describedherein may allow different elements to be distinguished from each other,despite close proximity or partial overlap.

In some examples, a plurality of trackable objects (e.g., first object500 and second object 510) may be used to form a dynamic reference base(DRB) that is attached to a patient and/or serves as a reference towhich other tracked objects are related. To make an object into anavigated element, it may be shaped or marked in unique ways. In oneembodiment, an object may have contrasting (e.g., black and white)stripes painted on its shaft, or have slight variances in diameter suchthat sections are elevated or recessed and appear as stripes, withspacing between stripes being a consistent amount. For example, thespacing between stripes may be 1 millimeter (mm) in one element and 2 mmin another element. A section or group of stripes may have apredetermined number of total stripes so that the computer 430 maylocalize an exact longitudinal position of the stripe cluster, providingaccuracy along and normal to the shaft of the element. If positionsensors 410 track a plurality of elements simultaneously, the differentstripe spacing allows the computer 430 to distinguish between elements.In other words, the frequency of the stripes may identify a trackingmarker 420 from other tracking markers 420 and the cluster of stripesmay provide the coordinates of the tracking marker 420.

FIG. 19 shows an object 520 with stripes 522 of different thicknesses, asingle stripe 524 between clusters of stripes 522, and a contrast of adark object 520 against white or silver stripes 522 and 524 (e.g.,retro-reflective tape). In some embodiments, unique identification ofobjects 520 may be a function of stripe frequency and/or stripethickness. Additionally or alternatively, a stripe 524 between clustersmay facilitate improving tracking accuracy and/or localizationrobustness. The color configuration shown in FIG. 19 may facilitateincreasing contrast in surgical environments while visually separatingthe object 520 from the background. Applying localized colors such asred, green, and/or blue to an object 520 may also provide additionalfeedback to surgeons and/or systems. The example approaches describedherein have the advantage of encoding more information and beingcompatible with existing discrete and continuous linear barcode designprinciples. Additionally, the example approaches allow implantedhardware (e.g., screw tower 100, instrument 200, housing 300) to serveas a navigated array, allowing registration to be transferredsequentially as additional screws as placed and maintaining betteraccuracy.

FIG. 20 shows an example computing system 600 configured to perform oneor more computing operations. While some examples of the disclosure areillustrated and described herein with reference to the computing system600 being a computer 430 (shown in FIG. 15 ) and/or being used with acomputer 430, aspects of the disclosure are operable with any computingsystem (e.g., position sensor 410) that executes instructions toimplement the operations and functionality associated with the computingsystem 600. The computing system 600 shows only one example of acomputing environment for performing one or more computing operationsand is not intended to suggest any limitation as to the scope of use orfunctionality of the disclosure.

In some examples, the computing system 600 includes a system memory 610(e.g., computer storage media) and a processor 620 coupled to the systemmemory 610. The processor 620 may include one or more processing units(e.g., in a multi-core configuration). Although the processor 620 isshown separate from the system memory 610, examples of the disclosurecontemplate that the system memory 610 may be onboard the processor 620,such as in some embedded systems.

The system memory 610 stores data associated with one or more users,tracked objects, position sensors 410, and/or tracking markers 420, andcomputer-executable instructions, and the processor 620 is programmed orconfigured to execute the computer-executable instructions forimplementing aspects of the disclosure using, for example, the computer430. The system memory 610 includes one or more computer-readable mediathat allow information, such as the computer-executable instructions andother data, to be stored and/or retrieved by the processor 620.

By way of example, and not limitation, computer-readable media mayinclude computer storage media and communication media. Computer storagemedia are tangible and mutually exclusive to communication media. Forexample, the system memory 610 may include computer storage media in theform of volatile and/or nonvolatile memory, such as read only memory(ROM) or random access memory (RAM), electrically erasable programmableread-only memory (EEPROM), solid-state storage (SSS), flash memory, ahard disk, a floppy disk, a compact disc (CD), a digital versatile disc(DVD), magnetic tape, or any other medium that may be used to storedesired information that may be accessed by the processor 620. Computerstorage media are implemented in hardware and exclude carrier waves andpropagated signals. That is, computer storage media for purposes of thisdisclosure are not signals per se.

A user or operator may enter commands and other input into the computingsystem 600 through one or more input devices 630 coupled to theprocessor 620. The input devices 630 are configured to receiveinformation. Example input device 630 include, without limitation, apointing device (e.g., mouse, trackball, touch pad, joystick), akeyboard, a game pad, a controller, a microphone, a camera, a gyroscope,an accelerometer, a position detector, and an electronic digitizer(e.g., on a touchscreen). Information, such as text, images, video,audio, and the like, may be presented to a user via one or more outputdevices 640 coupled to the processor 620. The output devices 640 areconfigured to convey information. Example, output devices 640 include,without limitation, a monitor, a projector, a printer, a speaker, avibrating component. In some examples, an output device 640 isintegrated with an input device 630 (e.g., a capacitive touch-screenpanel, a controller including a vibrating component).

One or more network components 650 may be used to operate the computingsystem 600 in a networked environment using one or more logicalconnections. Logical connections include, for example, local areanetworks, wide area networks, and the Internet. The network components650 allow the processor 620, for example, to convey information toand/or receive information from one or more remote devices, such asanother computing system or one or more remote computer storage media.Network components 650 may include a network adapter, such as a wired orwireless network adapter or a wireless data transceiver.

The examples described herein facilitate reducing the amount of softtissue damage during surgery (e.g., orthopedic spine and neurosurgery),which may lead to less pain, quicker recovery times, and/or lowerlikelihoods of infection. For example, FIG. 21 shows percutaneous screws

FIGS. 21 and 22 show an example tracking array 700 and a navigationarray-equipped rod 710 extending transversely across an upper portion ofone or more screws 712 (e.g., a tulip of a pedicle screw) and one ormore screw towers (e.g., screw tower 100 or 160) coupled to the upperportion of the screws 712. As shown in FIG. 21 , the tracking array 700may be coupled to a first screw tower 714 in a first phase. Once the rod710 is extended through the first screw tower 714, the tracking array700 may be uncoupled from the first screw tower 714 and coupled to asecond screw tower 716 in a second phase as shown in FIG. 22 .

The tracking array 700 and rod 710 each include a plurality of markers720 that may be tracked (e.g., using position sensors 410) during thefirst and second phases to enable the relative positions of the rod 710and first screw tower 714 to be determined (e.g., using the computer430). In this manner, the rod 710 may be extended through the firstscrew tower 714 and second screw tower 716 using feedback from thetracking system 400. For example, as shown in FIG. 23 , the display 432may aid in positioning the rod 710 by showing a distance 722 to thefirst screw tower 714 or second screw tower 716 and an alignment 724 ofthe rod 710 relative to an opening defined in the first screw tower 714or second screw tower 716 (e.g., longitudinal channel 138). While FIGS.21-22 show the tracking array 700 and rod 710 each including a pluralityof arms and a spherical marker at an end portion of each arm, thetracking array 700 and/or rod 710 may include one or more trackingmarkers 420 for tracking the rod 710, screws 712, first screw tower 714,and/or second screw tower 716.

FIG. 24 shows an example method 800 of providing a rod reduction tool.As shown in FIGS. 21 and 22 , the rod 710 may extend transversely acrossan upper portion of a screw 712 and a screw tower (e.g., screw tower 100or 160) coupled to the upper portion of the screw 712. As shown in FIGS.25-27 , the screw tower 100 may be rigidly and/or robustly coupled tothe screw 712 to allow for screw manipulation orcompression/distraction. In some examples, a driver shaft (e.g., innershaft 210) is extended longitudinally through the screw tower 100 atoperation 810. For example, a distal end 104 of the driver shaft may beinserted into the proximal opening 106 of the screw tower 100 and movedin the distal direction. A threaded sleeve 220 may be mounted on aproximal portion of the driver shaft at operation 820 to form theinstrument 200.

A housing 300 may be coupled to the screw tower 100 using one or moreretention members (e.g., tower clips 310) at operation 830. The housing300 may be threadably coupled to the threaded sleeve 220 using athreaded button 320 at operation 840. The threaded sleeve 220 isrotatable about a longitudinal axis to urge the driver shaftlongitudinally relative to the screw tower 100. The driver shaft beingable to protrude through a locking cap allows the instrument 200 toachieve rod reduction without putting extraneous force on the lockingcap, thereby mitigating a likelihood of premature damage to the lockingcap and/or tulip. In some examples, the screw tower 100, instrument 200,and/or housing 300 may be marked and used as locating and/or guidancedevices for inserting interconnecting rods.

The previously mentioned examples allow for quick and robust connectionto a bone screw and tulip and also allows for reduction instrumentationto connect within a small footprint. The internal variable reduction isnot only robust, but also does keeps the outer diameter of the screwtower slim, minimizing the incision size. The following instrumentationmay also function with other instrumentation to allow for othertechnique related steps including but not limited to: rod measuring, rodpassage, rod reduction, locking cap attachment and tightening,compression, and distraction. The following embodiments represent anapproach that may be used to hold a pedicle screw to a tower-basedinstrument; a tube-based device allowing rod passage, rod reduction, andlocking cap delivery and tightening following screw implantation.Reduction embodiments may allow for free moving reduction followed bymechanically assisted reduction to save time by allowing particularorientations or intermittent functionality of certain internalcomponents not possible in all minimally invasive screw instrumentationsystems. Additionally, the potential ability to use instrumentation fromother currently available Globus systems may reduce the number of setsrequired in the operating room, may streamline the procedure, and mayalso reduce operating room time due to a potentially more streamlinedtechnique.

This written description uses examples to disclose aspects of thedisclosure and also to enable a person skilled in the art to practicethe aspects, including making or using the above-described systems andexecuting or performing the above-described methods. Having describedaspects of the disclosure in terms of various examples with theirassociated operations, it will be apparent that modifications andvariations are possible without departing from the scope of thedisclosure as defined in the appended claims. That is, aspects of thedisclosure are not limited to the specific examples described herein,and all matter contained in the above description and shown in theaccompanying drawings shall be interpreted as illustrative and not in alimiting sense. For example, the examples described herein may beimplemented and utilized in connection with or applied to other examplesand applications without departing from the scope of the disclosure.Thus, the aspects of the disclosure are not intended to be limited tothe above description and/or accompanying drawings, but are to beaccorded the broadest scope consistent with the principles and featuresdisclosed herein.

It is to be understood that the present disclosure is not limited in itsapplication to the details of construction and/or the arrangement ofcomponents set forth in the description herein or illustrated in thedrawings. For example, in accordance with the principles of thedisclosure, any feature described herein and/or shown in the drawingsmay be referenced and/or claimed in combination with any other featuredescribed herein and/or shown in the drawings. Skilled artisans willrecognize the examples provided herein have many useful alternatives andfall within the scope of the disclosure.

The teachings of the present disclosure may be used and practiced inother embodiments and practiced or carried out in various ways. Forexample, components of the systems and/or operations of the methodsdescribed herein may be utilized independently and separately from othercomponents and/or operations described herein. Moreover, the methodsdescribed herein may include additional or fewer operations than thosedisclosed, and the order of execution or performance of the operationsdescribed herein is not essential unless otherwise specified. That is,the operations may be executed or performed in any order, unlessotherwise specified, and it is contemplated that executing or performinga particular operation before, contemporaneously with, or after anotheroperation is within the scope of the disclosure. Moreover, thefunctionality of a given block of the flowcharts and/or block diagramsmay be separated into multiple blocks, and/or the functionality of twoor more blocks of the flowcharts and/or block diagrams may be at leastpartially integrated. Furthermore, although some of the diagrams includearrows on communication paths to show a primary direction ofcommunication, it is to be understood that communication may occur inthe opposite direction to the depicted arrows.

It should be apparent from the foregoing description that one or moreblock diagrams described herein may represent conceptual views ofillustrative circuitry embodying the principles of the disclosure andthat various examples may be implemented in hardware and/or as computerprogram instructions stored on a non-transitory machine-readable storagemedium. Computer program instructions may be provided to a processor ofa general purpose computer circuit, a special purpose computer circuit,and/or other programmable data processing circuit to produce a machine,such that the instructions, which execute via the processor, transformand control transistors, values stored in memory locations, and otherhardware components within such circuitry to perform the operationsdescribed in detail herein, including the functions/acts associated withthe blocks of the flowcharts and/or block diagrams, and thereby createmeans (functionality) and/or structure for performing such operations.It will be appreciated by those skilled in the art that any flowcharts,sequence diagrams, state transition diagrams, pseudo code, and the likerepresent various processes that may be substantially represented inmachine-readable storage media and so executed by a computer orprocessor, whether or not such computer or processor is explicitlyshown.

Unless otherwise defined, all terms (including technical and scientificterms) used herein have the same meaning as commonly understood by oneof ordinary skill in the art to which present inventive concepts belong.It will be further understood that terms, such as those defined incommonly used dictionaries, should be interpreted as having a meaningthat is consistent with their meaning in the context of thisspecification and the relevant art and will not be interpreted in anidealized or overly formal sense unless expressly so defined herein.

When introducing aspects of the disclosure or the examples thereof, thearticles “a,” “an,” “the,” and “said” are intended to mean that thereare one or more of the elements, unless the context clearly indicatesotherwise. References to an “embodiment” or an “example” of the presentdisclosure are not intended to be interpreted as excluding the existenceof additional embodiments or examples that also incorporate the recitedfeatures. The phrase “one or more of the following: A, B, and C” means“at least one of A and/or at least one of B and/or at least one of C.”The term “and/or” includes any and all combinations of one or more ofthe associated listed items. It will be understood that although ordinalterms (e.g., “first,” “second,” “third,” etc.) may be used herein todescribe various elements/operations, these elements/operations shouldnot be limited by these terms. These terms are only used to distinguishone element/operation from another element/operation. Thus, a firstelement/operation in some embodiments could be termed a secondelement/operation in other embodiments without departing from theteachings of present inventive concepts. Furthermore, as used herein,the common abbreviation “e.g.”, which derives from the Latin phrase“exempli gratia,” may be used to introduce or specify a general exampleor examples of a previously mentioned item, and is not intended to belimiting of such item. The common abbreviation “i.e.”, which derivesfrom the Latin phrase “id est,” may be used to specify a particular itemfrom a more general recitation.

Also, it is to be understood that the phraseology and terminology usedherein is for the purpose of description and should not be regarded aslimiting. Use of the terms “including,” “comprising,” or “having,” andvariations thereof, herein is meant to encompass the items listedthereafter and equivalents thereof, as well as additional items. Unlessspecified or limited otherwise, the terms “mounted,” “connected,”“supported,” and “coupled,” and variations thereof, are used broadly andencompass both direct and indirect mountings, connections, supports, andcouplings. Further, “connected” and “coupled” are not restricted tophysical or mechanical connections or couplings. Moreover, when anelement is referred to as being “connected,” “coupled,” or “responsive,”and variations thereof, to another element, it can be directlyconnected, coupled, or responsive to the other element or interveningelements may be present. In contrast, when an element is referred to asbeing “directly connected,” “directly coupled,” or “directlyresponsive,” and variations thereof, to another element, there are nointervening elements present. Furthermore, “connected,” “coupled,”“responsive,” or variants thereof as used herein may include wirelesslycoupled, connected, or responsive.

The patentable scope of the invention is defined by the claims, and mayinclude other examples that occur to those skilled in the art. Suchother examples are intended to be within the scope of the claims if theyhave structural elements that do not differ from the literal language ofthe claims, or if they include equivalent structural elements withinsubstantial differences from the literal language of the claims.

What is claimed is:
 1. A tracking system for tracking one or moreobjects during a surgical procedure, said system comprising: a computerincluding a processor, memory, an input interface, and an outputinterface; a display in electronic communication with the outputinterface; a first screw tower positioned at a first location on apatient during the surgical procedure; a position sensor including acamera in electronic communication with the input interface of thecomputer; one or more first tracking markers disposed on the first screwtower, wherein the position sensor is configured to detect the one ormore first tracking markers to determine position sensor data of the oneor more first tracking makers; and the processor is configured toreceive the position sensor data and present the position of the firstscrew tower, via the display, in relation to an image of an anatomicalstructure of the patient.
 2. The system of claim 1, further comprising:a second screw tower positioned at a second location on the patient; andone or more second tracking markers disposed on the second screw tower.3. The system of claim 2, wherein the camera is an infrared cameraconfigured to detect light from the one or more first tracking markersand the one or more second tracking markers.
 4. The system of claim 3,wherein the one or more first tracking markers and the one or moresecond tracking markers are passive tracking markers.
 5. The system ofclaim 4, wherein the one or more first tracking markers is a firstcluster of stripes and the one or more second tracking markers is asecond cluster of stripes, wherein the first cluster of stripes has aninter-stripe spacing different from the second cluster of stripes. 6.The system of claim 4, wherein the one or more first tracking markers isa first cluster of stripes and the one or more second tracking markersis a second cluster of stripes, wherein the first cluster of stripes hasa stripe thickness different from the second cluster of stripes.
 7. Thesystem of claim 1, further comprising a robot trackable by the positionsensor.
 8. The system of claim 7, further comprising a surgical tooltrackable by the position sensor.
 9. The system of claim 8, furthercomprising a patient tracking device secured to the patient that istrackable by the position sensor.
 10. The system of claim 2, wherein theone or more first tracking markers and the one or more second trackingmarkers are unique identifiers trackable in three dimensions.
 11. Atracking system for tracking one or more objects during a surgicalprocedure, said system comprising: a computer; a first object positionedat a first location on a patient during the surgical procedure; aposition sensor including a camera in electronic communication with thecomputer; one or more first tracking markers disposed on the firstobject, wherein the position sensor is configured to detect the one ormore first tracking markers to determine position sensor data of the oneor more first tracking makers and provide the position sensor data tothe computer.
 12. The system of claim 11, further comprising: a secondobject positioned at a second location on the patient; and one or moresecond tracking markers disposed on the second object.
 13. The system ofclaim 12, wherein the camera is an infrared camera configured to detectlight from the one or more first tracking markers and the one or moresecond tracking markers.
 14. The system of claim 13, wherein the one ormore first tracking markers and the one or more second tracking markersare passive tracking markers.
 15. The system of claim 14, wherein theone or more first tracking markers is a first cluster of stripes and theone or more second tracking markers is a second cluster of stripes,wherein the first cluster of stripes has an inter-stripe spacingdifferent from the second cluster of stripes.
 16. The system of claim14, wherein the one or more first tracking markers is a first cluster ofstripes and the one or more second tracking markers is a second clusterof stripes, wherein the first cluster of stripes has a stripe thicknessdifferent from the second cluster of stripes.
 17. The system of claim11, further comprising a robot trackable by the position sensor.
 18. Thesystem of claim 17, further comprising a surgical tool trackable by theposition sensor.
 19. The system of claim 18, further comprising apatient tracking device secured to the patient that is trackable by theposition sensor.
 20. The system of claim 12, wherein the one or morefirst tracking markers and the one or more second tracking markers areunique identifiers trackable in three dimensions.